An increasing number of HIV infected children are being started on stavudine containing antiretroviral treatment regimens in India. The incidence and pattern of metabolic complications among these children are not known. We propose to conduct a prospective study at two sites in South India to study the incidence and risk factors for the development of metabolic complications and body shape abnormalities among HIV infected children between the ages of 2 and 10 years, after 12 months of ART. Specifically, we will study the role of genetic factors (single nucleotide polymorphisms in APOA5, APOC3, APOE, CETP and PLIN genes) in the development of metabolic complications, namely fat redistribution, insulin resistance and dyslipidemia. 400 HIV infected children will be studied prospectively, at 2 sites in South India. Various risk factors and lipid gene polymorphism will be correlated with lipodystrophy, lipoatrophy, dyslipidemia and insulin resistance. The study will provide information, not currently available, on the metabolic complication of HIV and ART, in children between the ages of 2 and 10 years of age after 12 months of Stavudine containing antiretroviral treatment regimen. This knowledge of risk factors will be crucial to inform physicians and policy makers in order to design better treatment strategies for children. PUBLIC HEALTH RELEVANCE: This prospective study will determine the incidence and risk factors for the development of metabolic syndrome in HIV infected children, 12 months after starting antiretroviral therapy, with special focus on the role of baseline nutritional status and polymorphisms in genes of lipid metabolism. This study will throw light on the reasons why some children on antiretroviral therapy develop metabolic complications like dyslipidemia, body shape abnormality and insulin resistance, while others don't. The study has implications for ART programs in India and other resource-constrained countries that are using Stavudine in the first-line ART regimen for children.